MPT: Where does the college stand in terms of how to improve the nation's response to Ebola?

Gerardi: Emergency physicians relish their roles being on the front line. We're on the front line with Ebola. And we're finding out that there are certain ways Ebola patients should be treated or looked for rather than the way it's being done right now.

We really think there should be a regionalization of centers. In other words, put the experts who really know how to put on an PPE and other technical equipment and take it off safely in concentrated centers. Concentrated centers that are more likely to see these patients and also have the expertise by doing it frequently enough so that they don't put themselves in danger.

Four thousand hospitals in the U.S. should not go through all the training necessary to be experts in PPE like they should be in regional centers. The federal government is already having equal risk patients come through five major airports. Those five major airports are surrounded by certain medical centers that are going to be given the responsibility to be the regional Ebola centers such as Bellevue in New York, or Saint Louis University Hospital or Rush here in Chicago.

MPT: What is the biggest priority that you plan to tackle this year as president of the college?

Gerardi: One of my major initiatives this year as president of this college is to tackle the psychiatric patient boarding problems in emergency departments. It is inhumane that a lot of patients, especially adolescent patients, sometimes live in an emergency department for days. We have stories of patients in the emergency department waiting for a bed, a patient bed, for over a week.

That's got to stop.

In fact, there are models out there now where you can take a person in a mental health crisis to a separate screening and treatment center, not an emergency department, and you have the same outcomes with safety and more humane treatment. In fact, their length of stay are dramatically shorter in these -- it's called the Alameda model -- outpatient centers.

The length-of-stay for admitted patients qualified for bed, about 25% of patients under twenty hours, which is phenomenal. Not only do they initiate the treatment earlier in these centers, but they give them intensive outpatient therapy, the patients are much more happy, and they decompress the emergency department of these patients.

I think it's going to work. We have a coalition meeting in December with stake holders, the National Association of Mental Illness, pharmaceuticals are going to be involved, the American Academy of Pediatrics is going to be involved and other people who have a lot of interest in trying to find a better way to treat our mentally ill health patients.

Now there's a lot of stigma, there's a lack of parity and coverage for these patients, but we really have to take care of them and help them more efficiently and properly than just go to the emergency room.

Gerardi: Number one: they have to be evidence-based. Number two: they connect with the physician or the patient and don't increase medical or legal risk. And number three: they have to be something that an emergency physician can actually follow.

So, for instance, CT scans for spine are sometimes required by protocol, and our emergency physicians are sometimes obligated to follow protocols.

When possible, you should have a conversation with the patient because a CAT scan for a patient with syncope is probably not indicated. Most of the time it's not indicated.

A second CAT scan that tends to be done a lot, not because of our medical legal requirement, is a CAT scan with a CT angiography of the chest because of the risk of pulmonary embolism. However, when you take out patients with a very low pretest probability, it's really highly -- a lot of radiation or the risk thereof but a positive diagnosis.

So using D-dimers or readings about prevalence type statistics we can now recommend that CT angiography of the chest is not indicated for the subset of patients with very low pretest probability. So we're excited about that one in particular.

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